Does major surgery induce immune suppression and increase the risk of postoperative infection?

Torrance, Hew D.T.; Pearse, Rupert M; O’Dwyer, Michael J.

doi:10.1097/aco.0000000000000331

Cited by 52 publications

(48 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The surgical trauma and associated tissue damage induce acute inflammation, immunosuppression and catabolism, which makes the surgical patient vulnerable to post‐operative complications including respiratory failure, cardiovascular complications and severe sepsis . Post‐operative complications have been shown to be more important for survival after major surgery than pre‐operative patient risk factors .…”

Section: Discussionmentioning

confidence: 99%

Short‐ and long‐term mortality in major non‐cardiac surgical patients admitted to the intensive care unit

Ekeloef

Thygesen

Gögenur

2019

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Worldwide, more than 310 million surgical procedures are undertaken each year with an in-hospital mortality rate between 1.5% and 1.9% in developed countries. 1-3 High-risk patients represent a smaller proportion of the surgical population but accounts for more than 80% of the post-operative deaths. 2 A large database study reported a post-operative mortality of 0.42% in the standard surgical population and 12.3% in the high-risk population. 2 Post-operative complications seems to be the most important cause for poor surgical outcomes, admission to the intensive care unit (ICU) and shortand long-term post-operative mortality. 4-6 Patients undergoing major non-cardiac surgery make out a considerable proportion of the admissions to the ICU and utilise large amounts of resources. 7 While large population-based studies have characterised the high-risk surgical population in general, 2,3 few studies have specifically identified and characterised the high-risk surgical population admitted to the ICU following surgery. By exploring factors associated with morbidity and mortality on the short and long term for this patient group, it might be possible to identify clinically modifiable factors leading to better outcomes. The aim of this study was to characterize patients admitted to the ICU following non-cardiac surgery and identify risk factors associated with 30-days, 90-days and 1-year mortality after ICU admission. Background: The aim of this register-based cohort study was to characterize patients admitted to the intensive care unit (ICU) following non-cardiac surgery and identify risk factors associated with 30-days, 90-days and 1-year mortality after ICU admission. Methods: Patients aged 18+ years admitted to the intensive care unit within 30-days of non-cardiac surgery at four Capital Region hospitals in Denmark between January 2005 and December 2014 were included. Patients were identified through the Danish National Patient Register. The outcomes were 30-days, 90-days and 1-year mortality after ICU admission. Unadjusted and multivariate logistic regression analyses were performed to identify independent risk factors of mortality. Results:The study included 3311 ICU patients. Gastrointestinal surgery accounted for 71.3%, orthopaedic surgery for 18.4% and urologic surgery for 10.2% of the population. For the total population, the median length of stay in hospital was 18 days (9-36, 25th-75th percentile) and 2 days (1-4, 25th-75th percentile) in the ICU. Thirtydays, 90-days and 1-year mortality were 37.8%, 44.5% and 51.2% respectively.Mortality within the ICU was 22.3% while the post-ICU in-hospital mortality was 19.4%. Higher age, comorbidity, delayed ICU admission, acute surgery, and gastrointestinal and orthopaedic surgery increased 30-days, 90-days and 1-year mortality.Conclusions: Short-and long-term mortality in non-cardiac surgical patients admitted to the ICU is very high, especially among the elderly comorbid patients undergoing acute surgery. Future research should focus on targeting clinically modifiable r...

show abstract

Section: Discussionmentioning

confidence: 99%

Short‐ and long‐term mortality in major non‐cardiac surgical patients admitted to the intensive care unit

Ekeloef

Thygesen

Gögenur

2019

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

show abstract

“…Since every major surgical intervention results in stress for the patient's body and immune suppression during the postoperative recovery may occur, a patient undergoing elective surgery should to be as well prepared as possible, especially during the descend of the pandemic curve [101,102].…”

Section: Considerations On Perioperative Pharmacologic Prophylaxismentioning

confidence: 99%

Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS–COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management

Kaye¹,

Paprottka²,

Escudero³

et al. 2020

Aesth Plast Surg

101

145

View full text Add to dashboard Cite

Background The worldwide spread of a novel coronavirus disease has led to a near total stop of nonurgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the selfimposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen. Defining manageable, evidence-based protocols for testing, surgical/ procedural risk mitigation and clinical flow management/contamination management will be paramount for the safety of non-urgent surgical procedures. Methods We conducted a MEDLINE/PubMed research for all available publications on COVID-19 and surgery and COVID-19 and anesthesia. Articles and referenced literature describing possible procedural impact factors leading to exacerbation of the clinical evolution of COVID-19positive patients were identified to perform risk stratification for elective surgery. Based on these impact factors, considerations for patient selection, choice of procedural complexity, duration of procedure, type of anesthesia, etc., are discussed in this article and translated into algorithms for surgical/anesthesia risk management and clinical management. Current recommendations and published protocols on contamination control, avoidance of crosscontamination and procedural patient flow are reviewed. A COVID-19 testing guideline protocol for patients planning to undergo elective aesthetic surgery is presented and recommendations are made regarding adaptation of current patient information/informed consent forms and patient health questionnaires. Conclusion The COVID-19 crisis has led to unprecedented challenges in the acute management of the crisis, and the wave only recently seems to flatten out in some countries. The adaptation of surgical and procedural steps for a riskminimizing management of potential COVID-19-positive patients seeking to undergo elective aesthetic procedures in the wake of that wave will present the next big challenge for the aesthetic surgery community. We propose a clinical algorithm to enhance patient safety in elective surgery in the context of COVID-19 and to minimize cross-contamination between healthcare workers and patients. New evidence-based guidelines regarding surgical risk stratification, testing, and clinical flow management/contamination management are proposed. We believe that only the continuous development and broad implementation of guidelines like the ones proposed in this paper will allow an early reintegration of all aesthetic procedures into the scope of surgical care currently performed and to prepare

show abstract

“…This physiological response involves dynamic changes in gene regulation, and the acute shifts in DNA methylation observed here parallel the immunological responses to major surgery that underlie the post-operative recovery (7). It is therefore plausible that in addition to modulating the immune response to major surgery, DNA methylation might be involved in regulating susceptibility to certain postoperative complications such as nosocomial infection, delirium, and cognitive dysfunction (4,5). Given the growing need to optimise surgical recovery in our aging population, our findings highlight how perioperative molecular approaches might provide insight into the pathophysiology of surgical complications, and future work will focus on stratifying individuals to identify methylomic signatures of poor outcome (26).…”

Section: Discussionmentioning

confidence: 86%

“…Importantly, surgery evokes acute inflammatory and immunological responses, which results directly from the trauma of surgery itself that act to modulate wound healing and other physiological pathways (1)(2)(3). Of note, changes to the immunological milieu following major surgery are thought to mediate risk for a number of postoperative complications including nosocomial infections (4), and postoperative cognitive dysfunction and delirium (5).…”

Section: Introductionmentioning

confidence: 99%

Major surgery induces acute changes in DNA methylation associated with activation of the immune response

Sadahiro¹,

Knight

James

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Surgery is an invasive procedure evoking acute inflammatory and immune responses that are believed to mediate risk for postoperative complications including cognitive dysfunction and delirium. Although the specific mechanisms driving these responses have not been well-characterized, they are hypothesized to involve the epigenetic regulation of gene expression. We quantified genome-wide levels of DNA methylation in purified peripheral blood mononuclear cells (PBMCs) longitudinally collected from 55 elderly patients undergoing three types of major surgery (elective colorectal and hip replacement surgery, and emergency hip fracture surgery), comparing samples collected at baseline to those collected immediately post-operatively and at discharge from hospital. Results:Major surgery was associated with acute changes in DNA methylation at sites annotated to immune system genes, paralleling changes in serum-levels of markers including C-reactive protein (CRP) and Interleukin 6 (IL-6) measured in the same individuals.Although many of the observed changes in DNA methylation are consistent across the three types of surgery, there is notable heterogeneity between surgery types at certain loci. The acute changes in DNA methylation induced by surgery are relatively stable in the postoperative period, generally persisting until discharge from hospital. Conclusions:Our results highlight the dramatic alterations in gene regulation induced by invasive surgery, primarily reflecting upregulation of the immune system in response to trauma, wound healing and anaesthesia.

show abstract

Does major surgery induce immune suppression and increase the risk of postoperative infection?

Cited by 52 publications

References 56 publications

Short‐ and long‐term mortality in major non‐cardiac surgical patients admitted to the intensive care unit

Short‐ and long‐term mortality in major non‐cardiac surgical patients admitted to the intensive care unit

Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS–COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management

Major surgery induces acute changes in DNA methylation associated with activation of the immune response

Contact Info

Product

Resources

About